Addressing poor sleep quality to improve IBD health outcomes

Have you ever noticed that when you get a good night’s sleep, you feel better physically and emotionally? That is because there is a connection between your sleep and intestinal inflammation. Unfortunately, not every IBD patient gets good sleep. Research estimates that over 75% of IBD patients with active disease report sleep disturbances. According to previous studies, patients say that sleep disturbance is one of the most important factors driving poor quality of life and that they believe that poor sleep contributes to gastrointestinal symptoms the following day.

A new study published in Inflammatory Bowel Diseases shows that poor sleep quality and sleep disturbances can lead to worsened outcomes for patients, including risk for hospitalization or surgery. In this study, the researchers studied a group of Crohn’s patients and a group of control subjects (non-IBD patients) to look for similarities between the groups and identify differences unique to the Crohn’s disease patients. 

The study participants completed a questionnaire that included the Pittsburgh Sleep Quality Index (PSQI) as well as questions about medication usage, tobacco, and alcohol consumption. Additional personal and medical information, such as medical history, medications, age, body mass index (BMI), and age, was obtained from the study subject’s electronic health records. In the Crohn’s patients, disease activity was assessed at a clinic appointment.

The study found that 77% of the Crohn’s subjects had a PSQI score of greater than 5, which indicates poor sleep. Common sleep disturbances included feeling too cold, difficulty falling asleep within 30 minutes, waking in the middle of the night, waking to use the bathroom, having nighttime pain, and using medications to help with sleep. The study also found that:

• Poor sleep quality is associated with clinical disease activity
• Patients with an increasing BMI and use of psychiatric medications (non-benzodiazepine) had greater odds of a PSQI score above 5
• PSQI score greater than 8 is associated with worsened outcomes, including hospitalization or surgery

Some studies have found that certain biologic medications – like vedolizumab and anti-TNFs – are associated with sleep improvements. Another recent study published in Crohn’s & Colitis 360 looked at one particular treatment – Cognitive Behavioral Therapy for Insomnia (CBT-I) – as an option to help IBD patients with sleep disturbances, pain, and depression. 

Among adults with chronic health conditions, including IBD, the most common sleep disturbance is insomnia –  a disorder where you have difficulty falling asleep, staying asleep, or early morning awakening at least three times a week for at least three months, and where these sleep problems result in other impairments, like fatigue or irritability. CBT-I has been shown to be effective in patients with and without other medical conditions. It is also recommended as the “first-line” treatment for insomnia – i.e., it is good to try CBT-I before trying medications. CBT-I involves:

• 4-8 visits with a sleep psychologist or another trained provider
• Sleep restriction therapy
• Stimulus control
• Relaxation training
• Cognitive therapy
• Sleep hygiene education

Both studies recommended that more screening for sleep disorders needs to take place in clinical practice for intervention. CBT-I is a very effective intervention but is underutilized and not always widely available.

Keeping a sleep diary and keeping note of the different things that are keeping you awake at night or waking you up from sleep are important for identifying any symptoms that need to be addressed. If you are experiencing sleep disturbances, we encourage you to bring your concerns up with your healthcare provider.

Rebecca Kaplan is the Public Affairs and Social Media Manager for the Crohn's & Colitis Foundation and the caregiver of a Crohn's disease patient.